Provider Demographics
NPI:1326207853
Name:PHYSICIANS IMAGING-IBERVILLE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PHYSICIANS IMAGING-IBERVILLE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-526-9711
Mailing Address - Street 1:4650 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5416
Mailing Address - Country:US
Mailing Address - Phone:337-562-9711
Mailing Address - Fax:337-562-9737
Practice Address - Street 1:59295 RIVER WEST DR
Practice Address - Street 2:SUITE D
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764
Practice Address - Country:US
Practice Address - Phone:225-238-0034
Practice Address - Fax:225-238-0064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS IMAGING-IBERVILLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039985Medicaid